Dispensing truths | The Guardianhttps://www.theguardian.com/society/series/dispensing-truths
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The day I worked for the NHS 111 helpline | Peter Dawsonhttps://www.theguardian.com/society/2013/may/14/day-worked-nhs-111-helpline
Despite the compassion of the call handlers, I believe patients seeking medical advice want to speak directly to a doctor they know<p>Olive is 82 years old and&nbsp;lives independently in sheltered accommodation. Her chronic heart and chest conditions are compounded by an ever-worsening short-term memory. She didn't know the carer putting on the kettle and preparing her medication was the second one to do so that morning.</p><p>Olive drank more tea, ate more toast, and then overdosed on all of her tablets. The carer realised the error when she belatedly read the medication administration sheet. She contacted the district nurse, who called the NHS non-emergency helpline, 111.</p> <a href="https://www.theguardian.com/society/2013/may/14/day-worked-nhs-111-helpline">Continue reading...</a>NHSHealthGPsDoctorsSocietyTue, 14 May 2013 12:00:02 GMThttp://www.theguardian.com/society/2013/may/14/day-worked-nhs-111-helplinePhotograph: Graham Turner/GuardianWouldn't it be better to pay GPs to take back out-of-hours telephone triage? Photograph: Graham Turner for the GuardianPhotograph: Graham Turner/GuardianWouldn't it be better to pay GPs to take back out-of-hours telephone triage? Photograph: Graham Turner for the GuardianPeter Dawson2013-05-14T12:00:02ZIs the NHS's journey of reform a fool's errand? | Peter Dawsonhttps://www.theguardian.com/society/2013/mar/19/gps-nhs-commissioning-conflict-interest
Danger lies in conflicts of financial interest that GPs face in serving on clinical commissioning groups<p>All Fools' Day marks the start of the latest NHS reforms in England. Legislation is now in place to compel embryonic <a href="http://www.theguardian.com/society/2013/mar/12/clinical-commissioning-groups-nhs-direction" title="">GP-led clinical commissioning groups</a> to tender the bulk of current and proposed services on the open market. So, uninformed as they are by any evidence base, the reforms may be seen as a radical experiment to reshape our health services through the use of market forces. As such they raise serious concerns – one of which is my GP colleagues' inherent conflict of interest.</p><p>It goes without saying that local GPs should have a strong say in the design of local health services. In considering, for example, tenders for a community dementia care service, those GPs with special interest in dementia are the very people required to rigorously evaluate the submissions. But, almost by definition, their interest dictates that they, too, will have submitted a tender. They need to be present for their expertise, and to be absent because of their financial interest.</p> <a href="https://www.theguardian.com/society/2013/mar/19/gps-nhs-commissioning-conflict-interest">Continue reading...</a>GPsDoctorsNHSHealthSocietyTue, 19 Mar 2013 16:30:01 GMThttp://www.theguardian.com/society/2013/mar/19/gps-nhs-commissioning-conflict-interestPhotograph: AlamyGPs will have the potential to benefit personally by influencing prescribing and directing patients to their in-house pharmacies. Photograph: AlamyPhotograph: AlamyGPs will have the potential to benefit personally by influencing prescribing and directing patients to their in-house pharmacies. Photograph: AlamyPeter Dawson2013-03-19T16:30:01ZWhy do GPs prescribe too many drugs? | Peter Dawsonhttps://www.theguardian.com/society/2013/feb/19/nhs-weighs-report-to-cut-medicine-waste
York Health Economics Consortium puts the cost to the NHS of unwanted prescriptions in England at about £300m a year<p>An elderly customer had presented me with a shopping bag neatly packed with several months' worth of prescriptions, all sealed with our pharmacy label.</p><p>Why was she returning them? Well, she politely explained that she didn't want to upset her doctor by telling him, but she felt better without them. She just couldn't bear waste, and hoped other people might benefit from them. I then had to explain to a person who couldn't bear waste that, under the NHS contract, her medicines, worth several hundred pounds, unopened or otherwise, had to be disposed of by incineration.</p> <a href="https://www.theguardian.com/society/2013/feb/19/nhs-weighs-report-to-cut-medicine-waste">Continue reading...</a>NHSHealthGPsDoctorsSocietyPharmaceuticals industryBusinessTue, 19 Feb 2013 14:03:07 GMThttp://www.theguardian.com/society/2013/feb/19/nhs-weighs-report-to-cut-medicine-wastePhotograph: Matt Rourke/APPrescription medicines are the dominant medical intervention in primary care, creating a huge stock of unused drugs that are incinerated. Photograph: Matt Rourke/APPhotograph: Matt Rourke/APPrescription medicines are the dominant medical intervention in primary care, creating a huge stock of unused drugs that are incinerated. Photograph: Matt Rourke/APPeter Dawson2013-02-19T14:03:07ZPatients must be involved in decisions to change their medication | Peter Dawsonhttps://www.theguardian.com/society/2013/jan/22/patients-involved-decisions-change-medication
Yes, the NHS should be prescribing cheaper medicine but failing to explain to patients why their brand of medication has changed causes anxiety and confusion<p>The elderly lady had urgently asked to see the pharmacist, and was clearly distressed. I feared some error had been made with her medication, but she had been alarmed not by dispensing, but by correspondence. A&nbsp;letter from the doctor is something few older people take lightly.</p><p>For some years she had been taking a single tablet each morning for her blood pressure. Now a letter had arrived blithely informing her that her tablets "have now been classified as a Black Light drug. This means they are no longer recommended for prescribing on the NHS". The letter went on to say that her GP would switch her to two separate prescriptions equivalent to her current treatment, that her repeat prescription had been changed accordingly on the practice computer, but could she use up her current supply before ordering new tablets, to avoid waste. The letter was signed "on behalf of the surgery", with no indication of individual responsibility.</p> <a href="https://www.theguardian.com/society/2013/jan/22/patients-involved-decisions-change-medication">Continue reading...</a>NHSGPsDoctorsHealthSocietyTue, 22 Jan 2013 13:00:01 GMThttp://www.theguardian.com/society/2013/jan/22/patients-involved-decisions-change-medicationPhotograph: AlamyChanging the shape or colour of tablets significantly increases the likelihood that patients will stop taking their treatment as prescribed. Photograph: AlamyPhotograph: AlamyChanging the shape or colour of tablets significantly increases the likelihood that patients will stop taking their treatment as prescribed. Photograph: AlamyPeter Dawson2013-01-22T13:00:01ZBetter access to patient records is essential to make the NHS a safer placehttps://www.theguardian.com/society/2012/dec/18/better-access-patient-records-nhs-safer
Paternalistic dogma that regards patient records as the property of doctors and institutions must be discarded to make way for shared personal health records<p>Two weeks ago one of our patients, a 59-year-old woman with a diagnosis of vascular dementia and epilepsy, living alone with the daily support of carers, had been treated in hospital after an apparent fall. She was back home, but required further supplies of her new medications.</p><p>Wynn, her domiciliary carer, came to&nbsp;the pharmacy to collect the customised monthly dosette trays, and she told us how much better her client was on the new tablets after coming out of hospital. The alarm bells sounded. The pharmacy technician, who had painstakingly prepared the trays, cursed. Once again, we had been unaware of alterations to treatment.</p> <a href="https://www.theguardian.com/society/2012/dec/18/better-access-patient-records-nhs-safer">Continue reading...</a>NHSHealthSocietyTue, 18 Dec 2012 14:03:16 GMThttp://www.theguardian.com/society/2012/dec/18/better-access-patient-records-nhs-saferPhotograph: AlamyUp to 70% of patients do not receive their proper medication after discharge from hospital. Photograph: AlamyPhotograph: AlamyUp to 70% of patients do not receive their proper medication after discharge from hospital. Photograph: AlamyPeter Dawson2012-12-18T14:03:16ZThe NHS is failing to supply coeliac patients with gluten-free prescriptionshttps://www.theguardian.com/society/2012/nov/20/gluten-free-prescriptions-lottery
Primary care trusts ration the type, range and number of gluten-free products available. We can only hope this will change when they are replaced by clinical commissioning groups in April<p>6 x 400g bread, white unsliced</p><p>1,000g penne pasta</p> <a href="https://www.theguardian.com/society/2012/nov/20/gluten-free-prescriptions-lottery">Continue reading...</a>NHSHealthCommunitiesGPsSocietyDiets and dietingHealth policyTue, 20 Nov 2012 13:30:01 GMThttp://www.theguardian.com/society/2012/nov/20/gluten-free-prescriptions-lotteryPhotograph: Martin Argles/GuardianGluten-free food is essential for people with coeliac disease. Photograph: Martin Argles for the GuardianPhotograph: Martin Argles/GuardianGluten-free food is essential for people with coeliac disease. Photograph: Martin Argles for the GuardianPeter Dawson2012-11-20T13:30:01ZOur social environment encourages obesityhttps://www.theguardian.com/society/2012/oct/16/our-social-environment-encourages-obesity
We can't begin to treat obesity when the food and drink industry has so much invested in it<p>Simon is squeezed into a chair, trapped in the pharmacy consultation area, waiting for his prescriptions. Last year he retired from a career in teaching, and has been gaining weight ever since. He is well aware his waistline shapes his health, and believes I'm about to nag him.</p><p>At the beginning of the year, pharmacists, along with GPs, nurses and other health professionals, signed up to the government's Making Every Contact Count campaign. Sounding more like the exhortations of a rugby league coach, it is actually one of the NHS Future Forum proposals to reduce health inequalities. Each and every contact with the public is to be seen as an opportunity to help them improve their health. Although it is considered to be a core responsibility in the NHS, there is no funding, and the evidence base to support it is limited.</p> <a href="https://www.theguardian.com/society/2012/oct/16/our-social-environment-encourages-obesity">Continue reading...</a>ObesityNHSHealthSocietyTue, 16 Oct 2012 15:00:01 GMThttp://www.theguardian.com/society/2012/oct/16/our-social-environment-encourages-obesityPhotograph: Christopher Thomond/GuardianLifestyle advertising and product placements encourage ever more consumption. Photograph: Christopher Thomond for the GuardianPhotograph: Christopher Thomond/GuardianLifestyle advertising and product placements encourage ever more consumption. Photograph: Christopher Thomond for the GuardianPeter Dawson2012-10-16T15:00:01ZGrief is good news for pharmaceutical companieshttps://www.theguardian.com/society/2012/aug/14/grief-good-news-big-pharma
The proposal by the American Psychiatric Association to create a new illness – prolonged grief disorder – and to redefine children's mental health is the stuff of dreams for Big Pharma<p>She was a tearful, older woman holding a bulging bin liner. Community pharmacies are collection points for society's <a href="http://www.theguardian.com/society/2012/jul/03/prescription-medicine-unused" title="">redundant medicines</a>, and the bin liner – her late husband's medical legacy and stark testament to over-prescribing – was dispatched for disposal. I&nbsp;listened as she reflected on how empty, her life had suddenly become. She needed help sleeping. I gave her maximum bedtime doses of an antihistamine known to cause drowsiness.</p><p>The funeral was a month since, and her continued grieving would seem normal and necessary. But, in fact, a&nbsp;major reappraisal is under way.</p> <a href="https://www.theguardian.com/society/2012/aug/14/grief-good-news-big-pharma">Continue reading...</a>NHSHealthMental healthOlder peopleChildrenSocietyPharmaceuticals industryBusinessBereavementLife and styleDepressionTue, 14 Aug 2012 11:30:01 GMThttp://www.theguardian.com/society/2012/aug/14/grief-good-news-big-pharmaPhotograph: i love images/Alamy/AlamySymptoms of grief lasting for more than two weeks may be diagnosed as depression. Photograph: AlamyPhotograph: i love images/Alamy/AlamySymptoms of grief lasting for more than two weeks may be diagnosed as depression. Photograph: AlamyPeter Dawson2012-08-14T11:30:01ZWhy age should not dictate healthcare fundinghttps://www.theguardian.com/society/2012/jul/10/age-not-dictate-healthcare-funding
An age-based allocation of funds that the health secretary favours would benefit areas that are the most wealthy, healthy and likely to vote Conservative<p>Michael's carer comes in with her shopping bag and makes her usual joke about really needing a trolley. She is collecting his medicines. Michael seldom leaves the flat. He is 55 and has heart disease, lung disease ("twenty-one years of gobbling coal dust"), diabetes and depression. He says everything hurts.</p><p>His therapeutics have been compiled by consultants, each one seemingly tethered to Michael's particular organ of interest. The clinical psychologist, respirologist and diabetologist may be strangers to one another, but their ethereal gathering as co-prescribers in the pharmacy generates a plethora of clinical and logistical issues. Warnings sound as prescriptions are entered into his data base. His anti-depressants must be used with care as they could worsen his heart condition. His cardiovascular drugs can interfere with his diabetic control. His painkillers constipate, his laxatives make him flatulent. His inhalers give him thrush, and so on. Each day he takes at least 54 tablets. The many potential drug interactions must each be assessed for clinical relevance. I choose to override the computer generated warning that would deny him a glass of beer.</p> <a href="https://www.theguardian.com/society/2012/jul/10/age-not-dictate-healthcare-funding">Continue reading...</a>NHSHealthPublic financeSocietyAndrew LansleyPoliticsHealth policyPublic services policyTue, 10 Jul 2012 13:08:46 GMThttp://www.theguardian.com/society/2012/jul/10/age-not-dictate-healthcare-fundingPhotograph: Don McPheeDeprivation must be taken into account when allocating healthcare funding, says Peter Dawson. Photograph: Don McPheePhotograph: Don McPheeDeprivation must be taken into account when allocating healthcare funding, says Peter Dawson. Photograph: Don McPheePeter Dawson2012-07-10T13:08:46ZPharmacists must put care before commercehttps://www.theguardian.com/society/2012/jun/12/pharmacy-only-medicines-changes
Changes to the way that pharmacies operate will allow people to buy medicines that currently require professional advice<p>The counter assistant was struggling to comply with the sales protocol for "pharmacy-only" medicines. The customer, a young man seemingly bursting with health, was impatient, resentful of what he clearly felt to be intrusive and superfluous questioning. Why should there be interference in his right to choose what he wants?</p><p>Medicines are classified to promote their safe use. The class of <a href="http://www.nhs.uk/conditions/medicinesinfo/Pages/Introduction.aspx" title="">prescription-only medicines</a> has a rigorous evidence base to support its effectiveness. The risk-benefit ratios demand their restricted availability.</p> <a href="https://www.theguardian.com/society/2012/jun/12/pharmacy-only-medicines-changes">Continue reading...</a>NHSHealthSocietyDrugsSciencePharmaceuticals industryBusinessTue, 12 Jun 2012 12:30:01 GMThttp://www.theguardian.com/society/2012/jun/12/pharmacy-only-medicines-changesPhotograph: Graham Turner/GuardianPharmacy-only medicines have 'the power to do both good and harm'. Photograph: Graham Turner for the GuardianPhotograph: Graham Turner/GuardianPharmacy-only medicines have 'the power to do both good and harm'. Photograph: Graham Turner for the GuardianPeter Dawson2012-06-12T12:30:01ZWhy charging patients for prescriptions doesn't add uphttps://www.theguardian.com/society/2012/may/08/prescription-charges-ill-health-costs
The tax on prescriptions means many patients are not taking the medicines they need, which costs the NHS in the long run<p>The young man works at the local tyre garage. He has a typical asthmatic's prescription – bronchodilator inhalers for relief, steroid inhalers for prevention and a course of antibiotics. He tells me he doesn't need the last item. I tell him his GP thinks otherwise, but his concern is not with medical opinion, it is with economics and a prescription charge of £22.95, which I reckon to be about 10% of his weekly income. He is given an owing note for the antibiotics, in case he changes his mind, and is charged £15.30 for the inhalers.</p><p>Zoe is a care assistant in a local nursing home. Her prescription for antidepressants and analgesics had been written a few weeks ago. She tells me that because of the cost (from April prescription charges rose from £7.40 to £7.65 per item), she has been trying to get by without the prescription but is now at the end of her tether. Her obvious distress is not helped by my clumsy encouragement to persevere, advising her it could be another month before the antidepressants start to help. Selling her some alternative painkillers that are cheaper than a single prescription charge offers scant consolation.</p> <a href="https://www.theguardian.com/society/2012/may/08/prescription-charges-ill-health-costs">Continue reading...</a>NHSHealthSocietyTue, 08 May 2012 12:00:01 GMThttp://www.theguardian.com/society/2012/may/08/prescription-charges-ill-health-costsPhotograph: AlamyAt £7.65 per item, prescriptions are unaffordable for many poorer NHS patients. Photograph: AlamyPhotograph: AlamyAt £7.65 per item, prescriptions are unaffordable for many poorer NHS patients. Photograph: AlamyPeter Dawson2012-05-08T12:00:01ZSocial change can be the best contraceptionhttps://www.theguardian.com/society/2012/mar/13/social-change-the-best-contraception
Contraceptive advice is vital, but binge drinking and social deprivation can be a major factor in unwanted pregnancies and poor sexual health<p>Saturday morning and the first customer of the day had been waiting for the pharmacy to open. She asks for the morning-after pill. I&nbsp;invite her into the consultation room. I&nbsp;record her age (15 years, one month) and her initials, and start a structured interview that incorporates the <a href="http://www.nspcc.org.uk/inform/research/questions/gillick_wda61289.html" title="">Fraser guidelines, </a>which allow me to give contraceptive advice or treatment without parental consent to under-16s if I judge they have the maturity to make their own decisions and understand the implications on consent.</p><p>I ask why she is requesting the pill – a&nbsp;small proportion of clients do not need it, describing activities that could never lead to conception – but her sexual and menstrual history confirm that she meets the therapeutic criteria developed by the local primary care trust for emergency hormonal contraception. I explain how it works and give her a tablet with a&nbsp;glass of water, a kit for a postal chlamydia screen, an array of pamphlets on contraception and sexual health, and I&nbsp;strongly recommend that she visits the local contraceptive and sexual health (Cash) clinic for further advice.</p> <a href="https://www.theguardian.com/society/2012/mar/13/social-change-the-best-contraception">Continue reading...</a>Contraception and family planningSexual healthSocial exclusionNHSHealthSocietyTue, 13 Mar 2012 15:30:01 GMThttp://www.theguardian.com/society/2012/mar/13/social-change-the-best-contraceptionPhotograph: Matt Cardy/Getty ImagesMany requests for the morning-after pill are the result of a drunken night out Photograph: Matt Cardy/Getty ImagesPhotograph: Matt Cardy/Getty ImagesMany requests for the morning-after pill are the result of a drunken night out Photograph: Matt Cardy/Getty ImagesPeter Dawson2012-03-13T15:30:01ZDementia: a battle of hearts and mindshttps://www.theguardian.com/society/2012/feb/07/dementia-battle-hearts-minds
If what's good for our hearts is good for our heads, the implications for dementia management could be profound<p>It's blowing a gale outside, but Mary comes in wearing just a thin dress. She approaches the counter looking bewildered. Phillipa, a&nbsp;pharmacy assistant, sympathetically chides her for not dressing properly, and asks how she can help. Mary doesn't answer. Customers queue anxiously behind her. Phillipa asks if she has a prescription. Mary struggles to get a few words out. She can't explain what she wants. In private, the staff call her Scary Mary.</p><p>I invite her into the quiet of the consultation room. I talk slowly, allowing her the time she needs to keep up. Reviewing her medication history I suggest she may have come in for an inhaler. She cannot recall its name, but recognises it when I show it to her.</p> <a href="https://www.theguardian.com/society/2012/feb/07/dementia-battle-hearts-minds">Continue reading...</a>NHSHealthSocietyDementiaMental healthSocial careTue, 07 Feb 2012 14:07:40 GMThttp://www.theguardian.com/society/2012/feb/07/dementia-battle-hearts-mindsPhotograph: Will Stanton/AlamyDementia in the UK affects one in 20 people over the age of 60 and one in five over 80. Photograph: Will Stanton/AlamyPhotograph: Will Stanton/AlamyDementia in the UK affects one in 20 people over the age of 60 and one in five over 80. Photograph: Will Stanton/AlamyPeter Dawson2012-02-07T14:07:40ZWhy the methadone doesn't workhttps://www.theguardian.com/society/2012/jan/10/why-methadone-drugs-dont-work
Doling out methadone to heroin addicts has become a daily ritual for many pharmacies but the government needs to tackle the root causes of addiction<p>The first task of the day in the pharmacy is to prepare the methadone, a little over a gallon this morning. Its supervised daily consumption has been the mainstay of the harm reduction philosophy that has largely driven heroin addiction treatment for the past 20 years. Not all pharmacies supply methadone, but in those that do, the pharmacist sees addicts more regularly than any other health professional.</p><p>George, employed and drug-free for almost 10 years with her commitment to <a href="http://www.ukna.org/" title="">Narcotics Anonymous</a>, still tells me of the conflicting emotions she felt as each day she stood in my busy pharmacy with her daughter in the pram, and consumed the sticky green methadone mixture, followed by a glass of water to help stop her teeth rotting from it, gradually reducing the dose. Today, pharmacies have private rooms for such activities, but the daily grind continues. One inner-city pharmacy has even relocated to a former bank, and the walk-in vault is now the "drug cupboard" accommodating the quantity of methadone required.</p> <a href="https://www.theguardian.com/society/2012/jan/10/why-methadone-drugs-dont-work">Continue reading...</a>DrugsHealthNHSSocietySocial exclusionEqualityTue, 10 Jan 2012 15:00:00 GMThttp://www.theguardian.com/society/2012/jan/10/why-methadone-drugs-dont-workPhotograph: Danny Lawson/PA Archive/PA PhotosA heroin addict in recovery takes their prescription methadone. Photograph: Danny Lawson/PA Archive/PA PhotosPhotograph: Danny Lawson/PA Archive/PA PhotosA heroin addict in recovery takes their prescription methadone. Photograph: Danny Lawson/PA Archive/PA PhotosPeter Dawson2012-01-10T15:00:00ZNHS reforms will exacerbate the postcode lottery of healthcarehttps://www.theguardian.com/society/2011/nov/22/nhs-reforms-postcode-lottery-healthcare
In my 40-year career as a pharmacist, I don't ever recall the contrasts in health being as pronounced as they are now<p>Driving through the Yorkshire countryside belies the fact that my work this week as a locum is in an inner-city pharmacy in one of England's most deprived areas.</p><p>In the leafy suburbs, I am pursued by the "worried well"; requesting ever more screening, demanding the latest "breakthrough" treatment, attentively listening to advice on medications and lifestyle, and presenting requests for prescription repeats well ahead of time.</p> <a href="https://www.theguardian.com/society/2011/nov/22/nhs-reforms-postcode-lottery-healthcare">Continue reading...</a>NHSHealthPovertySocietyTue, 22 Nov 2011 15:00:00 GMThttp://www.theguardian.com/society/2011/nov/22/nhs-reforms-postcode-lottery-healthcarePhotograph: Clara Molden/PABy blaming people in poor communities for their own ill health, the government can absolve itself of responsibility, says Peter Dawson. Photograph: Clara Molden/PAPhotograph: Clara Molden/PABy blaming people in poor communities for their own ill health, the government can absolve itself of responsibility, says Peter Dawson. Photograph: Clara Molden/PAPeter Dawson2011-11-22T15:00:00Z